Síndrome de Ovario Poliquístico

Epidemiología y fisiopatología

Epidemiología

• Prevalencia: 5%–10% de las mujeres en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum edad reproductiva en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria Estados Unidos
• Una de las causas más comunes de:
  • Oligomenorrea
  • Amenorrea secundaria
  • Infertilidad
  • Hirsutismo (crecimiento anormal del vello facial y corporal)
• 50%–65% de las pacientes son obesas.

Fisiopatología

Se desconocen los LOS Neisseria mecanismos exactos, pero se cree que son complejos e incluyen tanto factores genéticos como ambientales. El síndrome metabólico y la obesidad están presentes a menudo, pero no siempre, y probablemente contribuyen a la fisiopatología en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum algunos individuos.

• El síndrome de ovario poliquístico (SOP) incluye:
  • Niveles elevados de andrógenos
  • Anovulación crónica
  • Ovarios de apariencia poliquística
  • Disfunción metabólica (comúnmente conocida como síndrome metabólico):
    • Resistencia a la insulina
    • Dislipidemia
    • Hipertensión
    • Asociada a la obesidad
    • ↑ Riesgo de diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus y enfermedad cardiovascular
• Disfunción del eje hipotálamo-hipofisario-ovárico:
  • ↑ Nivel de hormona luteinizante ( LH LH A major gonadotropin secreted by the adenohypophysis. Luteinizing hormone regulates steroid production by the interstitial cells of the testis and the ovary. The preovulatory luteinizing hormone surge in females induces ovulation, and subsequent luteinization of the follicle. Luteinizing hormone consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle):
    • Estimula la producción de testosterona en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las células de la teca ovárica
    • Los LOS Neisseria receptores de LH LH A major gonadotropin secreted by the adenohypophysis. Luteinizing hormone regulates steroid production by the interstitial cells of the testis and the ovary. The preovulatory luteinizing hormone surge in females induces ovulation, and subsequent luteinization of the follicle. Luteinizing hormone consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle tienden a estar sobreexpresados ​​ en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria ovarios poliquísticos.
    • Causa de ↑ LH LH A major gonadotropin secreted by the adenohypophysis. Luteinizing hormone regulates steroid production by the interstitial cells of the testis and the ovary. The preovulatory luteinizing hormone surge in females induces ovulation, and subsequent luteinization of the follicle. Luteinizing hormone consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle: ↑ Estrógeno de los LOS Neisseria adipocitos y folículos ováricos crónicamente anovulatorios → altera el pulso de la hormona liberadora de gonadotropina (GnRH) → ↑ secreción de LH LH A major gonadotropin secreted by the adenohypophysis. Luteinizing hormone regulates steroid production by the interstitial cells of the testis and the ovary. The preovulatory luteinizing hormone surge in females induces ovulation, and subsequent luteinization of the follicle. Luteinizing hormone consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle
  • Hormona folículo estimulante ( FSH FSH A major gonadotropin secreted by the adenohypophysis. Follicle-stimulating hormone stimulates gametogenesis and the supporting cells such as the ovarian granulosa cells, the testicular sertoli cells, and leydig cells. Fsh consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle):
    • La estimulación con FSH FSH A major gonadotropin secreted by the adenohypophysis. Follicle-stimulating hormone stimulates gametogenesis and the supporting cells such as the ovarian granulosa cells, the testicular sertoli cells, and leydig cells. Fsh consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle es insuficiente para la ovulación → desarrollo anormal del folículo
    • Evidencia de resistencia a la FSH FSH A major gonadotropin secreted by the adenohypophysis. Follicle-stimulating hormone stimulates gametogenesis and the supporting cells such as the ovarian granulosa cells, the testicular sertoli cells, and leydig cells. Fsh consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle a nivel folicular
  • Estrógeno crónico sin oposición:
    • No hay ovulación → ↓ progesterona
    • Resulta en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum proliferación endometrial sin menstruación
    • ↑ Riesgo de hiperplasia o carcinoma endometrial
• Hiperandrogenismo:
  • ↑ LH LH A major gonadotropin secreted by the adenohypophysis. Luteinizing hormone regulates steroid production by the interstitial cells of the testis and the ovary. The preovulatory luteinizing hormone surge in females induces ovulation, and subsequent luteinization of the follicle. Luteinizing hormone consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle → ↑ testosterona:
    • ↑ Insulina → sensibiliza al AL Amyloidosis ovario a la LH LH A major gonadotropin secreted by the adenohypophysis. Luteinizing hormone regulates steroid production by the interstitial cells of the testis and the ovary. The preovulatory luteinizing hormone surge in females induces ovulation, and subsequent luteinization of the follicle. Luteinizing hormone consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle
    • Las células de la teca sobreexpresan enzimas esteroidogénicas → ↑ testosterona
  • Probablemente implica una predisposición genética
  • Andrógenos secretados principalmente por los LOS Neisseria ovarios y las glándulas suprarrenales
• Resistencia a la insulina y obesidad:
  • ↑ insulina conduce a:
    • ↑ Producción de andrógenos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las células de la teca ovárica
    • ↓ Producción hepática de globulina transportadora de hormonas sexuales ( SHBG SHBG A glycoprotein migrating as a beta-globulin. Its molecular weight, 52, 000 or 95, 000-115, 000, indicates that it exists as a dimer. The protein binds testosterone, dihydrotestosterone, and estradiol in the plasma. Sex hormone-binding protein has the same amino acid sequence as androgen-binding protein. They differ by their sites of synthesis and post-translational oligosaccharide modifications. Gonadal Hormones)
  • Obesidad:
    • Los LOS Neisseria adipocitos convierten andrógenos → estrógenos → ↓ FSH FSH A major gonadotropin secreted by the adenohypophysis. Follicle-stimulating hormone stimulates gametogenesis and the supporting cells such as the ovarian granulosa cells, the testicular sertoli cells, and leydig cells. Fsh consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle → empeoramiento de la disfunción ovulatoria
    • ↑ Resistencia a la insulina → ↑ testosterona libre → ↑ hiperandrogenismo
    • ↑ Prevalencia del síndrome metabólico
    • No está claro si la obesidad en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum sí misma es causa del SOP

Presentación Clínica

El síndrome de ovario poliquístico (SOP) debe sospecharse en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum cualquier mujer en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum edad reproductiva con menstruaciones irregulares y/o síntomas de hiperandrogenismo, especialmente si es obesa o presenta infertilidad.

Síntomas del hiperandrogenismo

• Hirsutismo:
  • Exceso de vello corporal terminal
  • Distribución masculina:
    • Labio superior
    • Mentón
    • Periareolar
    • Línea alba
• Acné vulgar
• Alopecia Alopecia Alopecia is the loss of hair in areas anywhere on the body where hair normally grows. Alopecia may be defined as scarring or non-scarring, localized or diffuse, congenital or acquired, reversible or permanent, or confined to the scalp or universal; however, alopecia is usually classified using the 1st 3 factors. Alopecia de patrón masculino
• Adrenarquia temprana (desarrollo de vello púbico, glándulas apocrinas y glándulas sebáceas)

Irregularidades del ciclo menstrual

• Oligomenorrea (duración del ciclo > 35 días)
• Amenorrea (ausencia de ciclos)
• Síntomas presentes durante 3 a 6 meses o la duración de 3 ciclos
• Debido a anovulación crónica

Condiciones asociadas

• Síndrome metabólico:
  • Obesidad (especialmente con índice cintura:cadera ↑)
  • Hipertensión
  • Intolerancia a la glucosa:
    • Diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus mellitus tipo 2
    • Acantosis nigricans (marcador de resistencia a la insulina)
  • Dislipidemia
• Infertilidad
• Enfermedad cardiovascular
• Hiperplasia y carcinoma endometrial

Diagnóstico

El síndrome de ovario poliquístico (SOP) es un diagnóstico de exclusión, por lo que deben descartarse otras causas de oligo o amenorrea e hiperandrogenismo. Los LOS Neisseria criterios de Rotterdam se utilizan habitualmente para hacer el diagnóstico una vez que se han excluido otras causas.

Criterios de Rotterdam

El diagnóstico requiere 2 de los LOS Neisseria 3 criterios siguientes:

• Signos clínicos y/o bioquímicos de hiperandrogenismo
• Oligo- o anovulación
• Ovarios poliquísticos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la ecografía

Examen físico

• Hirsutismo:
  • Crecimiento de vello facial y corporal de patrón masculino
  • Puntuación de Ferriman-Gallwey:
    • Evaluación objetiva del hirsutismo
    • A menudo no es útil, ya que algunas mujeres eliminan el vello no deseado
  • Considere las variaciones étnicas normales en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el vello: Mediterránea, Mediooriental y Surasiática (más vello) > Caucásicas y personas de raza negra > del este de Asia ASIA Spinal Cord Injuries y nativo americanas (menos vello)
• Examen pélvico:
  • Agrandamiento leve de los LOS Neisseria ovarios
  • Descarte causas estructurales de sangrado anormal
• Signos del síndrome de Cushing (diagnóstico alternativo):
  • Cara de luna llena
  • Joroba de búfalo
  • Estrías abdominales

Laboratorio e imagenología

• Gonadotropina coriónica humana (hCG) en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum orina: descartar embarazo
• Evaluar otras posibles causas de sangrado anormal:
  • Hormona estimulante de la tiroides (TSH)
    • ↑ → hipotiroidismo
    • ↓ → hipertiroidismo
  • ↑ Prolactina → hiperprolactinemia
• Evaluar hiperandrogenismo bioquímico (y otras posibles causas de hirsutismo):
  • Testosterona libre: ↑ en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum SOP
  • Sulfato de dehidroepiandrosterona (DHEA-S): ↑ en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum ciertos tumores suprarrenales secretores de andrógenos
  • 17-hidroxiprogesterona: ↑ en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum hiperplasia suprarrenal congénita no clásica (NCCAH)
• Evaluar la posibilidad de síndrome metabólico:
  • Prueba de tolerancia a la glucosa de 2 horas
  • Panel lipídico en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum ayunas:
    • ↑ Triglicéridos y lipoproteínas de baja densidad (LDL)
    • ↓ Lipoproteínas de alta densidad (HDL)
• Otras pruebas de laboratorio a considerar:
  • Relación LH LH A major gonadotropin secreted by the adenohypophysis. Luteinizing hormone regulates steroid production by the interstitial cells of the testis and the ovary. The preovulatory luteinizing hormone surge in females induces ovulation, and subsequent luteinization of the follicle. Luteinizing hormone consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle: FSH FSH A major gonadotropin secreted by the adenohypophysis. Follicle-stimulating hormone stimulates gametogenesis and the supporting cells such as the ovarian granulosa cells, the testicular sertoli cells, and leydig cells. Fsh consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle del día 3 del ciclo → a menudo > 2 en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum SOP (lo normal es < 1)
  • Cortisol Cortisol Glucocorticoids libre urinario de 24 horas → cribado del síndrome de Cushing
• Ultrasonografía transvaginal:
  • “Perlas en un hilo” (también conocido como signo del collar de perlas): múltiples folículos antrales en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la periferia del ovario
  • ↑ Volumen ovárico
  • No es obligatorio si una mujer ya cumple con los LOS Neisseria criterios de Rotterdam.

Tratamiento

Manejo general

• Pérdida de peso:
  • Objetivo de reducción de peso del 5% al AL Amyloidosis ​​10%
  • ↓ Producción de estrógenos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria adipocitos → ↓ Inhibición de la FSH FSH A major gonadotropin secreted by the adenohypophysis. Follicle-stimulating hormone stimulates gametogenesis and the supporting cells such as the ovarian granulosa cells, the testicular sertoli cells, and leydig cells. Fsh consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle por el estrógeno → reanudación de la ovulación normal
  • ↓ Riesgo de síndrome metabólico
• Examen y tratamiento periódicos para:
  • Diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus
  • Dislipidemia
  • Hipertensión
  • Enfermedad cardiovascular
• Protección del endometrio:
  • El objetivo es ↓ el riesgo de hiperplasia o cáncer de endometrio.
  • Píldoras anticonceptivas orales combinadas → permiten un sangrado de privación regular Regular Insulin
  • Dispositivo intrauterino (DIU) que contiene levonorgestrel Levonorgestrel A synthetic progestational hormone with actions similar to those of progesterone and about twice as potent as its racemic or (+-)-isomer (norgestrel). It is used for contraception, control of menstrual disorders, and treatment of endometriosis. Hormonal Contraceptives → supresión endometrial
  • Terapia intermitente o continua con progestina

Manejo del hirsutismo

• Depilación mecánica (p. ej., cera, depilación láser)
• Píldoras anticonceptivas orales combinadas
  • ↓ LH LH A major gonadotropin secreted by the adenohypophysis. Luteinizing hormone regulates steroid production by the interstitial cells of the testis and the ovary. The preovulatory luteinizing hormone surge in females induces ovulation, and subsequent luteinization of the follicle. Luteinizing hormone consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle → ↓ producción de testosterona en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el ovario
  • ↑ SHGB → ↑ unión de testosterona → ↓ testosterona libre
  • ↓ DHEA-S en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las glándulas suprarrenales
  • ↓ actividad de la 5-α-reductasa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la piel
• Antiandrógenos:
  • Espironolactona
  • Finasterida
• Metformina:
  • Ya no es el tratamiento de primera línea para ninguna indicación de SOP
  • Aún se considera de primera línea en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes con diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus mellitus tipo 2
  • Agente sensibilizante a la insulina: ↓ producción hepática de glucosa → ↓ insulina → ↓ testosterona 
  • A pesar de la ↓ testosterona, hay una reducción limitada del hirsutismo.

Manejo de la infertilidad

• Letrozol:
  • Inhibidor de la aromatasa
  • Más eficaz en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la inducción de la ovulación y más seguro que el citrato de clomifeno en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el SOP
  • Actualmente se considera el tratamiento farmacológico de primera línea para la inducción de la ovulación en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum SOP, según las principales pautas, a pesar de no estar aprobado por la FDA para esta indicación.
  • ↓ Estrógeno → ↓ inhibición de la FSH FSH A major gonadotropin secreted by the adenohypophysis. Follicle-stimulating hormone stimulates gametogenesis and the supporting cells such as the ovarian granulosa cells, the testicular sertoli cells, and leydig cells. Fsh consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle → ↑ FSH FSH A major gonadotropin secreted by the adenohypophysis. Follicle-stimulating hormone stimulates gametogenesis and the supporting cells such as the ovarian granulosa cells, the testicular sertoli cells, and leydig cells. Fsh consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle → ↑ desarrollo folicular → ovulación
• Citrato de clomifeno:
  • Modulador selectivo del receptor Receptor Receptors are proteins located either on the surface of or within a cell that can bind to signaling molecules known as ligands (e.g., hormones) and cause some type of response within the cell. Receptors de estrógeno (SERM)
  • Aprobado por la FDA para tratar la infertilidad
  • Inhibe los LOS Neisseria efectos del estrógeno en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la hipófisis → ↑ FSH FSH A major gonadotropin secreted by the adenohypophysis. Follicle-stimulating hormone stimulates gametogenesis and the supporting cells such as the ovarian granulosa cells, the testicular sertoli cells, and leydig cells. Fsh consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle → ↑ desarrollo folicular → ovulación
• Fertilización in vitro

Diagnóstico Diferencial

• Hiperplasia suprarrenal congénita no clásica (HSCNC): una forma menos grave de deficiencia enzimática hereditaria (generalmente 21-hidroxilasa) que produce una disminución en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la producción de aldosterona y cortisol Cortisol Glucocorticoids. En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum cambio, los LOS Neisseria precursores se desvían hacia las vías de los LOS Neisseria esteroides sexuales, lo que conduce a un aumento de los LOS Neisseria andrógenos. Las pacientes desarrollarán hirsutismo, oligomenorrea e infertilidad. La 17-hidroxiprogesterona se encontrará elevada en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la hiperplasia suprarrenal congénita (HSC), pero será normal en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el SOP. El tratamiento incluye antiandrógenos y glucocorticoides. 
• Síndrome de Cushing: cortisol Cortisol Glucocorticoids elevado debido a la secreción excesiva de hormona adrenocorticotrópica (ACTH), tumores suprarrenales o esteroides exógenos. La presentación es similar al AL Amyloidosis SOP, con irregularidades menstruales e hirsutismo, así como estrías abdominales purpúreas, obesidad troncal y cara de luna. Las pacientes pueden ser evaluadas con una prueba de cortisol Cortisol Glucocorticoids libre en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum orina de 24 horas o una prueba de supresión con dexametasona. El tratamiento depende de la causa e incluye la suspensión de esteroides exógenos, inhibidores suprarrenales o cirugía para tumores. 
• Exposición a testosterona exógena: ocurre cuando la crema de testosterona de un hombre se transmite a una mujer a través de la exposición por contacto. Los LOS Neisseria pacientes pueden desarrollar hirsutismo; el diagnóstico se basa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la historia y en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria niveles elevados de testosterona.
• Tumores ováricos: tumores del estroma de los LOS Neisseria cordones sexuales que surgen de las células de la teca o de la granulosa dentro del ovario y secretan andrógenos o estrógenos, respectivamente. Las pacientes pueden presentar signos de virilización, ciclos menstruales irregulares o sangrado uterino anormal. Los LOS Neisseria niveles de andrógenos y estrógenos tienden a ser más elevados de lo que se observa normalmente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el SOP. El tratamiento inicial es quirúrgico y se basa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el estadio de malignidad.
• Hipotiroidismo: deficiencia de la hormona tiroidea que produce oligo- o amenorrea, lo que puede afectar negativamente la fertilidad. Es probable que los LOS Neisseria efectos se deban a las similitudes estructurales entre la TSH, la FSH FSH A major gonadotropin secreted by the adenohypophysis. Follicle-stimulating hormone stimulates gametogenesis and the supporting cells such as the ovarian granulosa cells, the testicular sertoli cells, and leydig cells. Fsh consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle y la LH LH A major gonadotropin secreted by the adenohypophysis. Luteinizing hormone regulates steroid production by the interstitial cells of the testis and the ovary. The preovulatory luteinizing hormone surge in females induces ovulation, and subsequent luteinization of the follicle. Luteinizing hormone consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle, así como a las disminuciones asociadas de la SHBG SHBG A glycoprotein migrating as a beta-globulin. Its molecular weight, 52, 000 or 95, 000-115, 000, indicates that it exists as a dimer. The protein binds testosterone, dihydrotestosterone, and estradiol in the plasma. Sex hormone-binding protein has the same amino acid sequence as androgen-binding protein. They differ by their sites of synthesis and post-translational oligosaccharide modifications. Gonadal Hormones. Otros síntomas incluyen pérdida del cabello, piel seca, uñas quebradizas, edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema periorbitario, estreñimiento y fatiga. La hormona estimulante de la tiroides (TSH) aumenta debido a la baja concentración de tiroxina. El hipotiroidismo se trata con levotiroxina.
• Embarazo: produce amenorrea, aunque por lo general no causa síntomas de hirsutismo. Se debe descartar el embarazo con una prueba de embarazo en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum orina al AL Amyloidosis evaluar la amenorrea. El tratamiento es la atención obstétrica.